Substance Use Disorder Treatment Research Articles

Subspecialty physicians’ perspectives on barriers and facilitators of hepatitis C treatment: a qualitative study

IntroductionThe hepatitis C virus (HCV) causes chronic and curable disease with a substantial burden of morbidity and mortality across the globe. In the United States (US) and other developed countries, incidence of HCV is increasing and people who inject drugs are disproportionately affected. However, HCV treatment rates amongst patients with substance use disorders (SUD) are suboptimal. In this study, we aimed to understand the perspectives of subspecialist physicians who care for substantial numbers of patients with HCV, including addiction medicine, infectious diseases, and hepatology physicians, to better understand barriers and facilitators of HCV treatment.MethodsWe recruited subspecialty physicians via purposive and snowball sampling and conducted semi-structured interviews with 20 physicians at 12 institutions across the US. We used a mixed deductive and inductive approach to perform qualitative content analysis with a rapid matrix technique.ResultsThree major themes emerged: (1) Perceptions of patient complexity; (2) Systemic barriers to care, and (3) Importance of multidisciplinary teams. Within these themes, we elicited subthemes on the effects of patient-level factors, provider-level factors, and insurance-based requirements.ConclusionOur results suggest that additional strategies are needed to reach the “last mile” untreated patients for HCV care, including decentralization and leverage of telehealth-based interventions to integrate treatment within primary care clinics, SUD treatment facilities, and community harm reduction sites. Such programs are likely to be more successful when multidisciplinary teams including pharmacists and/or peer navigators are involved. However, burdensome regulatory requirements continue to hinder this expansion in care and should be eliminated.

Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders

Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study. To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized population of adults aged 18 years and older. A survey of adults in a national sample of US households between October 2020 and October 2022. Participants drawn from a multistage, clustered, and stratified area probability sample of US households were included, excluding adults older than 65 years because of the difficulty of differentiating mental disorders from symptoms of dementia. The sample also included adults living in prisons, state psychiatric hospitals, and homeless shelters who were excluded from the sample of US households used in these analyses. Each sample household was sent a letter explaining the study and offering the option to complete the household roster online, by phone, or by email. Of the 12 906 adults selected for clinical interviewing in the household sample, 4674 completed clinical interviews. Main outcomes were Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs and responses to survey questions regarding treatment received. The Social Vulnerability Metric (SVM) and the Area Deprivation Index (ADI) were used to determine SV at the residential zip code level. The analysis involved 4674 participants (2904 [62.13%] female and 1770 [37.87%] male; mean [SD] age, 41.51 [13.41] years). Controlling for measured confounders, the SVM was significantly associated with diagnoses of schizophrenia spectrum disorder (SSD; adjusted odds ratio [aOR], 17.22; 95% CI, 3.05-97.29), opioid use disorder (OUD; aOR, 9.47; 95% CI, 2.30-39.02), stimulant use disorder (aOR, 6.60; 95% CI, 2.01-21.67), bipolar I disorder (aOR, 2.39; 95% CI, 1.19-4.80), posttraumatic stress disorder (aOR, 1.63; 95% CI, 1.06-2.50), and any MH disorder (aOR, 1.44; 95% CI, 1.14-1.83), but not major depressive disorder (MDD), generalized anxiety disorder (GAD), or any SUD. Results were similar for the ADI but generally of lower magnitude (SSD aOR, 11.38; 95% CI, 1.61-80.58; OUD aOR, 2.05; 95% CI, 0.30-14.10; stimulant use disorder aOR, 2.18; 95% CI, 0.52-9.18). Among participants with SSDs, SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18) and reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80). In contrast to previous studies using nonclinical symptom-based survey data, we found no association between SV and GAD or MDD. By contrast, there were associations of SV with prevalence of SSD, stimulant use disorder, and OUD with corresponding decreases in treatment. These results suggest that the SVM might assist in developing more comprehensive care models that integrate medical and social care for MH disorders and SUDs.

Patterns of substance use recovery following residential treatment: A repeated measures latent profile analysis.

Ongoing improvement to residential treatment for substance use disorders is critical as it typically targets people with the highest need. Assessing multiple recovery indicators, such as cravings and mental health, at intake and following discharge is important in evaluating treatment effectiveness. To refine services, research should explore whether there are subgroups of individuals with different patterns of recovery following treatment. Participants (n = 554) were attending Australian Salvation Army residential treatment services for substance use issues. Data were collected by surveys at intake and 3-month post-discharge ('early recovery'). Recovery indicators were cravings, confidence to resist substance use and the Depression, Anxiety and Stress Scale. Subgroups of individuals based on these recovery indicators ('profiles') were identified using repeated measures latent profile analysis. Five profiles were identified, three profiles improved over time (81.4%) and two (18.6%) deteriorated across all indicators. These two profiles had the poorest mental health and addiction scores at intake and reported shorter time in treatment compared to the three profiles showing improvement. There were no demographic or substance type differences between profiles. By considering initial severity and multiple recovery indicators at early recovery, this study suggests that individuals at-risk of poor early recovery can be identified at intake. This opens opportunities for tailored treatment approaches to address both mental health and substance use, thereby potentially improving treatment outcomes and reducing the risk of relapse.

Episodic Future Thinking Increases Quitting Intention and Reduces Cigarette Consumption: The Role of Anticipated Regret

Background: Episodic future thinking (EFT), which refers to people simulating possible future life events, has been suggested as a promising intervention for substance use disorders. Objectives: To examine the effect of gain-oriented and loss-oriented EFT on smoking cessation and its underlying mechanisms. Results: Two online experiments were conducted (Total N = 362). The results suggested that engaging in EFT led to increased short-term quitting behavior among smokers by bolstering their intentions to quit smoking (indirect effect = 0.10, bootstrap = 5000, bias-corrected 95% CI [0.0008, 0.2353]). Furthermore, the influence of EFT on quitting intention was mediated by anticipated regret (indirect effect = 0.37, bootstrap = 5000, bias-corrected 95% CI [0.2062, 0.5321]). There were no significant differences observed between the effects of gain-oriented and loss-oriented EFT on quitting intention (F = 0.28, p = .60). Importance: Our findings contribute to a growing body of literature on the adaptive functioning of EFT and lend support to the regret regulation theory. Health practitioners may consider integrating EFT into clinical interventions to help smokers quit smoking.

Associations Between Drug Overdose Mortality and Recovery Ecosystems in the United States: A County-Level Analysis Using a Novel Index.

Communities with robust recovery ecosystems could reduce negative outcomes associated with substance use disorders (SUDs) and facilitate the recovery process. This cross-sectional study examined the relationship between drug overdose mortality rates in the United States and the strength of county-level recovery ecosystems, as measured by the Recovery Ecosystem Index (REI). The REI assesses the strength of county-level recovery ecosystems in the United States. Comprised of 14 indicators across 3 component classes, overall and component scores ranging from "one" (strongest) to "five" (weakest) were calculated for each county using standardized values of the indicators. County-level analyses included: (1) correlational analyses between drug overdose mortality rates (n = 2076) and REI scores (overall score and by component); and (2) quadrant analysis (n = 2076), dividing counties based on their drug overdose mortality rates and overall REI scores. Drug overdose mortality rates were inversely related to REI overall, SUD treatment component, and continuum of SUD support component scores, indicating that lower (stronger) scores corresponded to higher rates. Conversely, REI infrastructure and social component scores were positively related to rates. Counties were relatively evenly distributed across quadrants, with 26% (n = 537) with a strong REI score and high overdose mortality rate, 24% (n = 489) with a strong REI score and low overdose mortality rate, 20% (n = 409) with a weak REI and high overdose mortality rate, and 31% (n = 641) with a weak REI and low overdose mortality rate. REI scores were generally inversely associated with drug overdose mortality rates in US counties, suggesting that communities have stronger recovery systems and services as the burden of SUD increases. Given relative variation in the scale of drug overdose mortality and strength of recovery ecosystems among counties, results could guide the identification of communities where the need for expanded recovery systems and services may be particularly critical.

“Just as expensive as sending him to college:” barriers and perceptions of treatment in justice-involved youth

BackgroundJustice-involved youth have higher rates of substance use disorders (SUDs) than the general population. Many do not connect with or complete treatment, leading to recidivism. This qualitative study explores perceptions and barriers to treatment in this population.ResultsJustice-involved youth participating in a larger study focused on access to SUD treatment were interviewed about available treatment and justice system involvement. Twenty-one dyads (youth and a guardian) and 3 individual guardians (total N = 45) were interviewed by phone. Inclusion criteria were youth aged 14–17 involved in the justice system that screened positive for SUD. Youth sample was 43% male. Thematic analysis guided the process. The study was Indiana University Institutional Review Board approved (#1802346939).Data was interpreted within the ecological system theory. Youth barriers included willingness to engage in treatment, time constraints/scheduling conflicts, and low perceived usefulness of treatment. Major guardian themes included high cost of treatment, lack of communication by the justice system about treatment, youth unwillingness or disinterest to engage in treatment, and limited program availability.ConclusionsThe barriers to treatment for justice-involved youth are multifaceted and occur across the spectrum of levels of the ecological system, which include parents, peers, social systems, and cultural elements. Many youth and guardians suggested improvements for their interactions with the juvenile justice system. Further examination is needed of current policy implementation to address these concerns.

Substance Use Patterns and Characteristics Using Real World Data from Adolescents Assessed for Substance Use and Treatment Planning-United States, 2017–2021

Background Although substance use rates among adolescents have decreased, drug overdose deaths among adolescents have increased since 2020, driven largely by illegally made fentanyl (IMF). This study explores substance use patterns and characteristics of adolescents who were assessed for substance use disorder (SUD) treatment to inform prevention and response strategies. Methods A convenience sample of adolescents aged 10–18 years assessed for SUD treatment from September 2017 to December 2021 was analyzed using the Comprehensive Health Assessment for Teens. The percentage of lifetime and past 30-day substance use was examined. Adolescent characteristics (e.g., demographics, history of overdoses or hospital visits due to drug/alcohol use) were analyzed by lifetime substances used. Results Among 5,377 assessments, most were male (58.7%), aged 16–18 years (50.5%), non-Hispanic White (43.1%), enrolled in school (87.3%), and living with their parent(s) (72.4%). The most commonly reported lifetime substances used were marijuana (68.0%), alcohol (54.2%), and prescription opioid misuse (13.6%). The most common past 30-day substance use combination was alcohol and marijuana (35.6%). The percentage of assessments indicating past-year overdoses or hospital visits due to drug/alcohol use was greatest among those who reported lifetime use of IMF (24.0%), followed by heroin (21.4%) and cocaine (15.3%). Overall, 2.3% reported lifetime IMF use and 0.6% thought IMF was causing them the most problems. Conclusions Findings inform opportunities to address substance use and increased IMF-involved overdose among adolescents. Continued overdose prevention and response strategies such as evidence-based education campaigns, naloxone distribution and harm reduction efforts, and evidence-based SUD treatment expansion are needed.

A Pilot Study of Twice-Weekly Group-Based Written Exposure Therapy for Veterans in Residential Substance Use Treatment: Effects on PTSD and Depressive Symptoms.

Posttraumatic stress disorder (PTSD) is highly comorbid with substance use disorders (SUDs), resulting in high prevalence of PTSD among individuals in residential SUD care. However, there is limited research on integrating trauma treatment into residential SUD care settings. The aim of the present project was to conduct an initial evaluation of the effects of group-based Written Exposure Therapy (WET) on PTSD and depressive symptoms that was integrated into programming for individuals in residential SUD treatment. Participants were 48 Veterans with comorbid PTSD-SUD from a 28-day residential SUD program at a Veterans Affairs Medical Center. Eligible participants were enrolled in 5 sessions of WET, delivered in twice-weekly in a group format. PTSD symptoms and depressive symptoms were assessed at each session with the Posttraumatic Stress Disorder Checklist, DSM-5 version (PCL-5) and the Patient Health Questionnaire (PHQ-9). Of the enrolled sample of 48 participants, 92% (n = 44) completed 3 sessions, while 56% (n = 28) completed 5 sessions. Dependent samples t-tests showed significant reductions from baseline in PTSD symptoms within-persons at both the 3-session (t(43) = 4.77, p < .001, d = .72) and 5-session mark (t(27) = 4.36, p < .001, d = .82). In addition, there were significant reductions in depressive symptoms after 3 sessions (t(38) = 3.01, p < .01, d = .48) and after 5 sessions (t(23) = 2.97, p < .01, d = .61). Findings demonstrate that brief, group-delivered WET shows promise for addressing PTSD and depressive symptoms in residential SUD treatment. Results of the present evaluation could inform further efficacy testing and implementation of PTSD treatment into residential SUD settings.

Exploring the Acute Effects of Immersive Virtual Reality Biking on Self-Efficacy and Attention of Individuals in the Treatment of Substance Use Disorders: A Feasibility Study.

The role of exercise programs during substance use disorder (SUD) treatment is considered particularly supportive in fostering positive psychological and behavioral changes. The treatment of SUD is a challenging and demanding process. Therefore, it is crucial to discover innovative methods to enhance and facilitate it. Integrating exercise into a virtual environment is an innovative approach for drug rehabilitation, offering multiple benefits to individuals undergoing treatment. The aim of this feasibility study was to explore the acute effects of cycling exercise in an immersive virtual reality (VR) environment on attentional control and self-efficacy expectations of individuals undergoing SUD treatment. A total of 20 individuals (mean age of 37.75 years) enrolled in a SUD treatment program participated in the study. They were instructed to complete a single session of cycling with a self-selected duration within the VR system. Following the cycling session, pre-post measures indicated a statistically significant improvement in self-efficacy expectations and attentional control measured with the Stroop test. The results revealed that participants expressed high levels of intention for future use, interest/enjoyment, and positive attitudes toward the VR exercise system. Qualitative data indicated that participants found the VR exercise system enjoyable, expressed a strong intention to use it, and did not encounter technical difficulties or negative emotions. In conclusion, it seems that engaging in a brief period of self-selected exercise within a virtual environment can result in temporary activation of cognitive changes, heightened self-efficacy expectations, and a motivating approach to increasing physical activity participation among individuals with SUD, thus suggesting the feasibility of this approach.

Correction: Treatment of Behavioral Addictions and Substance Use Disorders: a Focus on the Effects of Theta-Burst Stimulation Over the Pre-SMA

Correction: Treatment of Behavioral Addictions and Substance Use Disorders: a Focus on the Effects of Theta-Burst Stimulation Over the Pre-SMA

Which pediatric practices use substance use consultation services?

Substance use disorders (SUD) are common in adolescents and young adults, though few youth with SUD receive treatment, and rates of medication for substance use disorder treatment are much lower in youth compared to adults. Pediatric primary care could present an opportunity for youth with SUD to access medication, though pediatric providers may need support. Massachusetts has provided a substance use consultation line for pediatric providers since 2018. One large network of independent primary care practices within the state has been further supported by access to resources provided through a grant from the Substance Abuse and Mental Health Services Administration. In this paper, we describe the services provided in Massachusetts and examine whether additional resources are associated with increased use of the consultation line as a marker of provider engagement in SUD treatment.

Diagnostic pattern of mental, neurological and substance use disorders at primary health care facilities in Uganda

Integration of diagnosis and treatment for mental, neurological, and substance use (MNS) disorders into primary health care is a recommended strategy to improve access to services in low-and middle-income countries. Despite numerous initiatives for integration of mental health care in Uganda, there has not been an evaluation of health management information system (HMIS) records to determine whether MNS disorders are routinely diagnosed. We sought to determine diagnostic pattern of MNS disorders at primary health facilities in Wakiso and Kampala districts, the most populous regions of Uganda. Lower-level primary health facilities were visited to obtain records from HMIS registers, to document diagnoses of MNS disorders. Secondary data analysis was conducted and descriptive statistics reported. A total of 40 primary health care facilities were visited representing 58.6% of the health facilities in the study districts. More than half (54.8%) and almost all (87.5%) of the lower-level health facilities in Wakiso district and Kampala district respectively were visited. The proportion of MNS disorders diagnosed at lower-level primary health facilities in Uganda is very low with Epilepsy the most common MNS diagnosis recorded. Reasons for such low numbers of diagnoses at primary health facilities are discussed as are possible solutions.

A Source Control Model for Treatment-Resistant Substance Use Disorder.

We propose applying the "source control" model of infectious disease treatment to the management of treatment-resistant substance use disorder (SUD). We believe that this conceptual framework complements other models for understanding SUD, fills a gap in our current understanding of treatment-resistant SUD, and advances the destigmatization of SUD by reinforcing SUD as a disease similar to other medical conditions. The model also harmonizes the need for multimodal treatment and novel interventions for both acute supportive care and long-term treatment of SUD. In this manuscript, we discuss the justification for, as well as the strengths and limitations of, the "source control" model for the management of treatment-resistant SUD. We also discuss the model's potential to direct innovative research questions and therapeutic interventions.

M28 - RAE cHealth: A Digital Tool to Support Peer Recovery-Based Treatment for Substance Use Disorder and to Reduce Digital Inequity

M28 - RAE cHealth: A Digital Tool to Support Peer Recovery-Based Treatment for Substance Use Disorder and to Reduce Digital Inequity

W50 - Perceptions of Overdose Response Hotlines Among a Sample of People in Treatment for Substance Use Disorder

W50 - Perceptions of Overdose Response Hotlines Among a Sample of People in Treatment for Substance Use Disorder

T111 - The ATTC Network: 30 Years of Supporting EBP Implementation in SUD Treatment and Recovery Services

T111 - The ATTC Network: 30 Years of Supporting EBP Implementation in SUD Treatment and Recovery Services

The Impact of Medicaid Institutions for Mental Disease Exclusion Waivers on the Availability of Substance Abuse Treatment Services and the Varying Effect by Ownership Type.

Access to integrated care for those with co-occurring mental health (MH) and substance use disorders (SUDs) has been limited because of an exclusion in Medicaid on paying for SUD care for those in institutions for mental disease (IMDs). Starting in 2015, the federal government encouraged states to pursue waivers of this exclusion, and by the end of 2020, 28 states had done so. It is unclear what impact these waivers have had on the availability of care for co-occurring disorders and the characteristics of any facilities that expanded care because of them. Using data from the National Survey of Substance Abuse Treatment Services, we estimate a two-stage residual inclusion model including time- and state-fixed effects to examine the effect of state IMD SUD waivers on the percentage of facilities offering co-occurring MH and SUD treatment, overall and for residential facilities specifically. Separate analyses are conducted by facility ownership type. Results show that the adoption of an IMD SUD waiver is associated with 1.068 greater odds of that state having facilities offering co-occurring MH and substance abuse (SA) treatment a year or more later. The adoption of a waiver increases the odds of a state's residential treatment facility offering co-occurring MH and SA treatment by 1.129 a year or more later. Additionally, the results suggest 1.163 higher odds of offering co-occurring MH/SA treatment in private for-profit SA facilities in states that adopt an IMD SUD waiver while suggesting no significant impact on offered services by private not-for-profit or public facilities. Our study findings suggest that Medicaid IMD waivers are at least somewhat effective at impacting the population targeted by the policy. Importantly, we find that there are differential responses to these IMD waivers based on facility ownership, providing new evidence for the literature on the role of ownership in the provision of health care.

The Role of Repetitive Transcranial Magnetic Stimulation in Reduction of Opioid Craving; A Single Blinded Randomized Sham Controlled Clinical Trial

Abstract Background Opioid use disorder (OUD) poses a great concern due to problems associated with their abuse as well as fatal and non fatal overdose consequences. Craving has a complex relationship with opioid use and relapse. Developing new, effective treatments for substance use disorders (SUDs), including opioid use disorders is crucial. This study aimed to assess the effect of 18 sessions of high frequency (HF) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) on opioid craving in early abstinence using brief substance craving scale (BSCS) for Tramadol and morphine and Heroin craving questionnaire (HCQ) for Heroin craving. Results There was a statistically significant reduction in craving scores in the group of OUD patients receiving real rTMS compared to those receiving sham rTMS for both BSCS( p value = 0.044) and HCQ (p value = 0.002). A statistically significant positive correlation was revealed between the number of hospital admissions and the mean scores of post rTMS HCQ scores (r = 0.05, p value = 0.040). Conclusion High frequency 10 Hz rTMS over the left DLPFC for 18 treatment sessions reduced craving OUD patients during early abstinence. These preliminary results suggest that 10 Hz rTMS of the left DLPFC may be used in treatment of OUD; so our study recommends that use of rTMS in reduction of opioid craving in early abstinence.

Jenna's Project: Preventing Overdose and Improving Recovery Outcomes for Women Leaving Incarcerated Settings during Pregnancy and Postpartum Periods.

For people with opioid use disorder (OUD), transitioning from pregnancy to postpartum and from incarceration to the community is a time of increased risk for opioid overdose. This prospective project evaluated the extent of Jenna's Project's success in preventing overdoses and improving recovery outcomes by coordinating postrelease care in incarcerated OUD perinatal patients. Participants (N = 132) were pregnant or postpartum (1 year postdelivery) with OUD during incarceration and self-referred for postrelease services. From March 2020 to October 2021, participants could receive up to 6 months of postincarceration care coordination services (eg, regular communication, transportation, emergency housing, SUD treatment), medication to treat OUD (MOUD) and other treatment services. Outcomes included verified overdose (fatal), self-reported nonfatal overdose, reincarceration, active Medicaid, receipt of MOUD, presence of children living with participants, open Child Protective Services cases, and number of referrals for services. There were 0 nonfatal and 0 fatal overdoses at both 1 and 6 months postrelease, and 3 of 132 (2%) returned to incarceration. Significantly fewer participants had Medicaid at release (36%) and at 6 months postrelease (60%) than before incarceration (87%) (P < 0.001 for all 3 pairwise comparisons). At 6 months postrelease, significantly more participants reported MOUD receipt (51%) compared with before incarceration (39%) (P < 0.001). There was no significant change in the number of open Child Protective Services cases. Referrals for childcare or parenting services were the most common referrals provided. Immediate postrelease care coordination for pregnant and postpartum women with OUD was feasible and effective in preventing overdose, reincarceration, and promoting recovery outcomes.

A discrete subpopulation of PFC-LHb neurons govern cocaine place preference

Addiction is a complex behavioral disorder characterized by compulsive drug-seeking and drug use despite harmful consequences. The prefrontal cortex (PFC) plays a crucial role in cocaine addiction, involving decision-making, impulse control, memory, and emotional regulation. The PFC interacts with the brain’s reward system, including the ventral tegmental area (VTA) and nucleus accumbens (NAc). The PFC also projects to the lateral habenula (LHb), a brain region critical for encoding negative reward and regulating the reward system. In the current study, we examined the role of PFC-LHb projections in regulating cocaine reward-related behaviors. We found that optogenetic stimulation of the PFC-LHb circuit during cocaine conditioning abolished cocaine preference without causing aversion. In addition, increased c-fos expression in LHb neurons was observed in animals that received optic stimulation during cocaine conditioning, supporting the circuit’s involvement in cocaine preference regulation. Molecular analysis in animals that received optic stimulation revealed that cocaine-induced alterations in the expression of GluA1 subunit of AMPA receptor was normalized to saline levels in a region-specific manner. Moreover, GluA1 serine phosphorylation on S845 and S831 were differentially altered in LHb and VTA but not in the PFC. Together these findings highlight the critical role of the PFC-LHb circuit in controlling cocaine reward-related behaviors and shed light on the underlying mechanisms. Understanding this circuit’s function may provide valuable insights into addiction and contribute to developing targeted treatments for substance use disorders.